Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy

Phys Ther. 2017 Jan 1;97(1):61-70. doi: 10.2522/ptj.20150482.


Background and purpose: Clinical reasoning is essential to physical therapist practice. Solid clinical reasoning processes may lead to greater understanding of the patient condition, early diagnostic hypothesis development, and well-tolerated examination and intervention strategies, as well as mitigate the risk of diagnostic error. However, the complex and often subconscious nature of clinical reasoning can impede the development of this skill. Protracted tools have been published to help guide self-reflection on clinical reasoning but might not be feasible in typical clinical settings.

Case description: This case illustrates how the Systematic Clinical Reasoning in Physical Therapy (SCRIPT) tool can be used to guide the clinical reasoning process and prompt a physical therapist to search the literature to answer a clinical question and facilitate formal mentorship sessions in postprofessional physical therapist training programs.

Outcomes: The SCRIPT tool enabled the mentee to generate appropriate hypotheses, plan the examination, query the literature to answer a clinical question, establish a physical therapist diagnosis, and design an effective treatment plan. The SCRIPT tool also facilitated the mentee's clinical reasoning and provided the mentor insight into the mentee's clinical reasoning. The reliability and validity of the SCRIPT tool have not been formally studied.

Discussion: Clinical mentorship is a cornerstone of postprofessional training programs and intended to develop advanced clinical reasoning skills. However, clinical reasoning is often subconscious and, therefore, a challenging skill to develop. The use of a tool such as the SCRIPT may facilitate developing clinical reasoning skills by providing a systematic approach to data gathering and making clinical judgments to bring clinical reasoning to the conscious level, facilitate self-reflection, and make a mentored physical therapist's thought processes explicit to his or her clinical mentor.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Back Pain / etiology*
  • Back Pain / rehabilitation
  • Clinical Competence*
  • Clinical Decision-Making / methods*
  • Diagnosis, Differential
  • Diagnostic Errors / prevention & control
  • Humans
  • Male
  • Medical History Taking / methods
  • Mentoring / methods*
  • Middle Aged
  • Physical Examination / methods
  • Physical Therapy Specialty / education*
  • Physical Therapy Specialty / methods
  • Reproducibility of Results